Psychopathology PDF

Psychopathology – the scientific study of mental disorders More severe depression cases for males because they do not admit their emotions. Clinical psychology – applied branch of psychology...

Psychopathology – the scientific study of mental disorders More severe depression cases for males because they do not admit their emotions. Clinical psychology – applied branch of psychology that seek to understand, assess, and treat psychological conditions in clinical setting. Sex problems are embarrassing for filipinos. Abnormal psychology – the branch of psychology that studies unusual Going to faith healer instead of psychologist because of their beliefs. patterns of behavior, emotion and thought which may or may not indicate an underlying condition. Psychomedical tradition; faith healing (ex: concept of “usog”) Health psychology – field of psychology involving the effects of mental Torture techniques processes to physical health and how it can be change to improve a person’s chance of physical recovery Strappado: using rope Developmental psychopathology – study of changes in abnormal behavior Guillotine: using a metal blade that occur overtime. Garotte: using a metal wire or metal string Criteria for normality Pearl of anguish: using a metal ball Normal behavior Lobotomy: impairing blood to flow to certain parts of the brain; incertion of One’s behavior is similar to the behavior of other people in the society icepick into Arbitrary decisions Bloodletting: surgical removal of the patient’s blood Problems in average normality Trepanning or trephanation: removing part of the skull bone Certain group of individuals define what is socially acceptable and Criteria for determining abnormal behavior conforming Abnormality as a norm violation (ex: feeble-mindedness and intellectual Sometimes, those which are statistically significant may not be significant in giftedness) actual situation. Norms: stated and unstated rules of proper conduct Normality is social conformity Abnormality as statistical rarity. Some behaviors are non-conforming, yet normal Abnormality as personal discomfort. Problem of criminality; violations of social norms Abnormality as deviation from an ideal. Problem of social standards Abnormality as maladaptiveness. Normality is personal comfort Hippocrates and Galen: humoral psychology Ex: sadness is okay because one needs to be First stated that the brain can also be diseased What may be pleasing to one may not be pleasing to others Body fluids and temperaments Normality is a process Hippocrates: father of modern medicine One may be normal today but not tomorrow and vice-versa 1. Phlegmatic: phlegm, water, sluggish Everyone goes under adjustment and coping 2. Melancholy: black bile, earth, sad constantly It is a spectrum with ends of normality and abnormality 3. Choleric: yellow bile, fire, angry all the time 4 d’s Dysfunction - a breakdown in cognitive, emotional, or behavioral functioning 4. Sanguine: blood, air, cheerful and friendly person, and good (ex: worrying leads you to locking yourself up in your room) humor Distress – clinical disorders: distress to the individual (ex: ocd: taking 5 to 7 Thomas Szasz (1920-2012) showers everyday) Emphasized on society’s role that he found the whole concept of mental - Personality disorders: distress to others (ex: ocpd: sorted colors illness to be invalid, a myth of sorts. of rubber bands and pushpins) According to Szasz, the deviation that the society calls abnormal are simply Dangerousness – some behaviors and feelings are of potential harm to the “problems in living”, not signs of something wrong within the person. individual, such as suicidal gestures, or to others, such as excessive aggression. Definition is only used to control deviating, distressing, dangerous, and dysfunctional behavior. Deviance – unusual behavior not just from the society, but from the person’s usual behavior as well Martin Seligman and Steven Maier: learned helplessness theory of depression Culture People become anxious and depressed when they decide that they have no A people’s common history, values, institutions, habits, skills, technology, and control over the stress in their lives. arts. The depressive attributional style is A thin line that separates normality and abnormality. Causes: coercive, ineffective, inconsistent parents, media violence, and peer A typical behavior should be observed in this context. rejection Examples: Internal: in that the individual attributes negative events to personal failings Stable: in that, even after a particular negative event passes, the attribution Affects of one’s behavior are magnified. that “additional bad things will always be my fault” remains Hans Selye: general adaptation Global: in that the attribution extend across a variety of issues Used to understand relationship between stressful events and the body’s Most studies support the finding that negative cognitive styles precede and response to stress. are at risk for depression. Alarm: fight or flight response; the body goes through predictable responses Hopelessness theory regardless of the type of stressor. Expectation that desirable outcomes will not occur and that the person has Resistance: coping mechanisms no responses available to change this situation. Exhaustion: body’s defenses of adaptational resources are depleted. Rumination theory Eustress: the body eventually adapts to any stress in a positive manner. Rumination is defined as a tendency to repetitively dwell on sad experiences and thoughts, or to chew on material again and again. Joseph Wolpe: Systematic Desensitization/Graduated Exposure Therapy The most detrimental form of rumination may be a tendency to brood or to Gradually introducing objects patient fear regretfully ponder why an episode happened. For phobia treatment Aaron Beck: Cognitive Theory of Depression In vivo exposure: involves client exposure to the actual anxiety-evoking Father of cognitive therapy events rather than simply imagining these situation Cognitive bias: tendencies to process information in certain negative ways Flooding Depressive cognitive triad: depressed people make cognitive errors in Another form of exposure therapy is flooding, which refers to either in vivo thinking negatively about themselves, their immediate world, and their or imaginal exposure to anxiety-evoking stimuli for a prolonged period of future. time. Beck hopelessness scale: to know if the person has negative attitude towards In vivo flooding: consist of intense and prolonged exposure to the actual future. anxiety-producing stimuli. Negative schema: an enduring negative cognitive belief system about some Imaginal flooding: is based on similar principles and follows the same aspects of life. procedures except the exposure occurs In the client’s imagination instead of in daily life In a self-blame schema: individuals feel personally responsible for every bad thing that happens. Richard Lazarus: Stress-Appraisal/Cognitive Appraisal Theory With a negative self-evaluation schema: they believe that they can never do Stress is a two way process anything correctly. It involves the production of stressors by the environment, and the response Negative cognitive styles of an individual subjected to these stressors 1. Dichotomous or absolutist or black and white thinking Primary appraisal Seeing only the extremes of things, never in the middle In the stage of primary appraisal, an individual tends to ask questions like, “what does this stressor and/or situation mean?” and, “how can it influence Symptom of many mental illnesses, including borderline personality disorder me?” 2. Overgeneralization According to psychologist, the three typical answers to these questions are: “this is not important” “this is good” “this is stressful” Making generalization about a negative aspect Secondary appraisals 3. Personalization Involve those feelings related to dealing with the stressor or the stress it A tendency for individuals to relate external events to themselves, even when produces. there is no basis for making this connection. Positive secondary appraisal: uttering statements like, “I can do it if I do my 4. Selective abstraction best” Focuses on the negative Negative secondary appraisal: “I can’t do it; I know that I will fail” A detail is taken out of context and believed whilst everything else in the Perspective in viewing abnormality context is ignored. Psychoanalytic perspective: all behavior derived from unconscious childhood 5. Arbitrary inference experiences Evident when a depressed individual emphasizes the negative rather than the Behavioral perspective: improper learnings result to disorders positive aspects of situation. Humanistic-existentialist perspective: humans who can’t fulfill own 6. Labeling and mislabeling potentials develop disorders Involve portraying ones identity on the basis of imperfections and mistakes Neuroscience disorders: disorders are caused by imbalances in the made in the past and allowing them to define one’s true identity. neurotransmitters 7. Minimization Medical perspective: treats disorders as sicknesses Downplaying the significance of an event or emotion a common strategy in Spiritistic perspective: most ancient and animalistic perspective dealing with feelings of guilt. Determinants of abnormal behavior 8. Magnification Biological: genetic make-up, neurotransmitter imbalances, brain injury, etc. Psychological: frustration, stress, psychological deprivation, etc. Circumstantiality: inclusion of unnecessary details & answering in a round about manner. Sociocultural: poverty, war, residential mobility Perseveration: monotonous repetitious thoughts Physical: stress, frustration. Verbal behavior disorders Typical signs & symptom Stammering and stuttering Sensory disorders Neologism: coining new words Anesthesia: loss of sensitivity Word salad speech: total incoherence; mixture of unintelligible words Hypoesthesia: diminished sensitivity Verbigeration: monotonous repetitious speech Hyperesthesia: increased sensitivity Clanging: individuals only communicate with words that rhyme Paraesthesia: false or perverted sensitivity like tingling sensations Tangentiality: unrelated answers Perceptual disorders Logorrhea: continuous flow of thought illusion: erroneous perception in the presence of the stimulus Bradylalia: slowed talking Perception: erroneous perception in the absence of the stimulus Aphasia: inability to comprehend or to understand all forms of language Agnosia: difficulty in processing visual stimuli Types of aphasia Emotional disorders Nominal: sequence (ex: ruler to luler) Depression: feeling of objection, hopelessness Motor: inability to express through speaking: they cannot say it but can write Euphoria: a feeling of well-being it Dysphoria: an unpleasant mood Sensory: receive or decode information Apathy: no emotional reaction Motor behavior disorders Emotional ability: mood swings Echopraxia: imitating the movements or gestures of others Anxiety: state of apprehension, worry, unfounded fears Apraxia: difficulty with motor planning Levels of Anxiety Copropraxia: (ex: involuntary flashes middle finger without purpose or intention) Mild Compulsion: uncontrollable acts Learn new behavior Cataplexy: muscle weakness due to diminished muscle tone Person is alert Catalepsy: rigidity due to increased muscle tone Stomach butterflies Tremors: fine but sustained muscular contractions Moderate Chorea: involuntary, periodic, irregular, jerky movements Focus is on immediate concern Paralysis: loss of voluntary movements Perceptual field is narrowed Waxy flexibility: body of the patient becomes soft like wax Horse blind or tunnel vision Posturing: patient assumes and maintains a certain posture even for a long Can solve problems with assistance time Severe Memory disorders Vague and not focused Anosognosia: no memories of his own illness Feelings of dread and terror Confabulation: filling in memory gaps with imaginary experiences Cannot be redirected to a task Disorientation: can’t identify or recognize time, places and persons Panic Déjà vu: unfamiliar perceived as familiar Loss of rational thoughts Jamais vu: familiar perceived as unfamiliar Hallucinations Hypermnesia: increased memory Delusions Paramnesia: false or perverted memory Physical immobility and muteness Amnesia: loss of memory Thought disorders Types of amnesia Delusion: false belief a. biogenic: caused by brain damage or disease Phobia: abnormal irrational fear Retrograde: inability to retrieve information that was acquired before a particular date, usually the date of an accident or operation; remote memory Obsession: uncontrollable thoughts loss Anterograde: inability to transfer new information from the short-term store Moro reflex into the long-term store; recent memory loss An infantile reflex normally present in all infants/newborns up to 3 or 4 b. Psychogenic or dissociative or functional: caused by psychological trauma; months of age as a response to a sudden loss of support, when the infant repressed memory syndrome feels as if it is falling Generalized: origin is a rare psychological disorder and spontaneous recovery Palmar grasp reflex from amnesia in a comparatively short period of time is one of the characteristics of this disorder When an object is placed in the infant’s hand and strokes their palm, the fingers will close and the will grasp it with a palmar grasp Localized: when an individual has no memory of specific events that took place Symptom Selective: when a person can recall only small parts of events that took place Reported by patient in a defined period of time Syndrome Situation-specific: occurs as a result of a severely stressful event, as part of post-traumatic stress disorders Combination of sign and symptom Global: total memory loss; inability to recall both past and present Subsyndromal: characterized by or exhibiting symptoms that are not severe enough for diagnosis as a clinically recognize syndrome Memory Diogenes syndrome: self-neglect and hoarding The process by which we encode, store, and retrieve information Capgras syndrome: believing that a family member is replaced by an impostor Declarative memory: memory from factual information Cotard’s syndrome: nihilistic syndrome Procedural/nondeclarative memory: memory for skills and habit De clerambault syndrome: erotomaniac delusion Semantic memory: memory for general knowledge and facts about the world Stock holm syndrome: become close to perpetrator Episodic memory: memory for events that occur in a particular time, place, or context. Disorders: composed of syndromes and episodes Three-system approach to memory Diagnosis: either the disorder or the process of identifying the disorder; based on criteria Sensory memory: the initial momentary storage of information, lasting only an instant Comorbidity: likelihood of the presence of the disorder alongside another mental disorder Short-term memory: memory that holds information for 15 to 25 seconds Episode: syndrome experienced in a certain period of time; common in mood Long-term memory: memory that stores information on a relatively disorders permanent basis, although it may be difficult to retrieve; regarded as having several different components. Incidence: number of new cases diagnosed in a particular period of time Definition of terms Prognosis Clinical description: represents the unique combination of behaviors, Prediction or idea on how the disorder will develop in an individual thoughts, and feelings that make up a specific disorder; specify what makes Based on other individuals who suffered the same condition the disorder different from normal behavior or from other disorders. Bad or low prognosis: lower chance of getting treated or condition might Etiology: study of origins; has to do with why a disorder begins (what causes exacerbate it) and includes biological, psychological, and social dimensions Good prognosis: high chance that one can recover Treatment or therapy: a systematic procedure designed to change abnormal behavior into more normal behavior Prevalence Sex ratio: percentage of males and females suffering a disorder Percentage of the individuals in the population that have the condition Genotype: genetic makeup of an individual Pattern of the disorder Phenotype: observable characteristics Chronic course: meaning that they tend to last long time, sometimes a lifetime Sign Episodic course: in that the individual is likely to recover within a few months Objective; observed by other people only to suffer a recurrence of the disorder at a later time Hard sign: may be defined as an indicator of definite neurological deficit Time-limited course: meaning the disorder will improve without treatment in Soft sign: is an indicator that is merely suggestive of neurological deficit a relatively short period. Reflex Onset Rooting reflex Time when the disorder developed A reflex that is seen in normal newborn babies, who automatically turn the Acute onset: developing a disorder suddenly face toward the stimulus and make sucking (rooting) motions with the mouth Insidious onset: developing a disorder gradually when the cheek or lip is touched. Crisis Plantar reflex temporal state of severe emotional disorganization Reflex elicited when the sole of the foot is stimulated with a blunt instrument An upward response (extension) is known as the Babinski response Caused by Intellectual Giftedness Failure of coping mechanism 130 -144: moderately gifted Lack of support 145 – 159: highly gifted Goal 160 – 179: exceptionally gifted To return the individual to the pre-crisis level of functioning 180+: profound gifted One cannot improve the condition of a person in crisis Terence Tao: Chinese, IQ of 230 Adventitious crisis Christopher Herata: Indian, IQ of 225 Disaster, unplanned and accidental, catastrophic event Two Domains Situational crisis Externalizing Disorder External event that disturbs person’s equilibrium Outward-directed Loss or change of job, change in financial status, death of a love one, etc. Aggressiveness, noncompliance, overactivity and impulsiveness Neurodevelopmental Disorders Internalizing Disorder A group of disorders in which the development of the central nervous system Inward-focused is disturbed. Depressed, social withdrawal, and anxiety This can include developmental brain dysfunction, which can manifest as neuropsychiatric problems or impaired motor function, learning, language or Intellectual Disability (Mental Retardation or Intellectual Development non-verbal communication Disorder) The disorder typically manifest early in developmental, often before the child Intellectual deficits determined by intelligence testing and broader clinical enter grade school. assessment I. Intellectual Disabilities Significant deficits in adaptive functioning relative to the person’s age and cultural group in one or more of the following areas; communication, social Intellectual Disability (Mental Retardation or Intellectual Development participation, work or school, independence at home or in the community, Disorder) requiring the need for support at school, work, or independent life. Global Developmental Delay Onset during child development II. Communication Disorders Common Causes Language Disorder (Expressive and Mixed Receptive-Expressive Language Genetic Conditions Disorders) Problems at Birth and during pregnancy Speech Sound Disorder (Phonological Disorder) Lead Poisoning Childhood-Onset Fluency Disorder/Stuttering Health problems Social (pragmatic) Communication Disorder Fetal alcohol syndrome/Hidden disability Autism Spectrum Disorder (Pervasive Developmental Disorder / Autistic Disorder / Mindblindedness) When a woman drinks alcohol during pregnancy, she risk giving birth to a child who will pay the price – in mental and physical deficiencies – for his or Attention-Deficit/Hyperactivity Disorder her entire life. Specific Learning Disorder (Learning Disorder) Sign and Symptoms III. Motor Disorders (Motor Skills Disorders) Low birth weight Developmental Coordination Disorder Small head circumference Stereotypic Movement Disorder Failure to thrive IV. Tic Disorders Developmental delay Tourette’s Disorder Organ dysfunction Persistent (Chronic) Motor or Vocal Tic Disorder Facial abnormalities, including smaller eye openings, flattened cheekbones Provisional Tic Disorder Indistinct Philtrum: an underdeveloped groove between nose and upper lip Intellectual Disabilities Epilepsy Disability characterized by significant limitations both in intellectual Poor coordination/fine motor skills functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. Poor socialization skills, such as difficulty building and maintaining friendships and relating to groups This disability originates before the age of 18 Lack of imagination or curiosity Causes of neurodevelopmental disorders Learning difficulties, including poor memory, inability to understand concept During practical periods of development, genetics, substances and toxins, such as time and money, poor language comprehension, poor problem- nutritional deficiencies deprivation trauma, meningitis solving skills Behavioral problems, including hyperactivity, inability to concentrate, social Language Disorder (expressive and mixed receptive-expressive language withdrawal, stubbornness, impulsiveness, and anxiety disorders) Fragile X Syndrome Difficulties in the acquisition and use of language due to deficits in the comprehension or production of vocabulary, sentence structure and Inherited causes discourse. Trisomy 21/Down Syndrome/Mongolism Highly heritable st Individual born with an extra 21 chromosome Onset of symptoms in the early developmental period IQ is below 70 Substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, Most common cause academic achievement, or occupational performance, individually or in any combination. Overly friendly When a person has trouble understanding others or sharing thoughts, ideas, Smile and laugh and feelings completely Physical problems of rapid respiration Speech Sound Disorder (Phonological Disorder) (SSD) Simian Crease: Single line that runs across the palm. People usually have Diagnosed when speech sound production is not what would be expected three creases in their palms based on child’s age and developmental stage Signs of Intellectual Disability The disturbance causes limitations in effective communication that interfere Sit up, crawl, or walk later than other children; with social participation, academic achievement, or occupational performance, individually or in any combination Learn to talk later, or have trouble speaking Types of Speech Sound Errors Find it hard to remember things Omission: A child may leave out sounds in words and sentences Not understanding how to pay for things Ex: “I re a boo” (I read a book) Have trouble understanding social rules Substitution: a child may use an incorrect sound instead of the correct one Have trouble seeing the consequences of their actions Ex: “Wook a the wittle wamb” (Look at the little lamb) Have trouble solving problems Distortions: a child tries to make the right sound, but cannot produce it Levels of Intellectual Disability clearly Mild/Dull Normal Ex: the /s/ sound may whistle, or the air may come out of the sides of the mouth, making a “slushy” sound (“lateral lisp”) or, the tongue may push IQ 50 – 70, educable, Academic potential, Immature in social interactions between the teeth causing the “frontal lisp” Moderate Symptoms of SSD IQ 35 – 49, Trainable, incapable of learning, trained in nonacademic areas, Repeating sounds (most often seen in people who stutter) marked differences from peers in social and communicative behavior across development. Adding extra sound and words Severe Elongating words IQ 20 – 34, slight words and survival skills, generally has little understanding Making jerky movements while talking (usually involving the head) of written language or of concepts, requires support for all activities of daily living, spoken language is quite limited in terms of vocabulary and grammar Blinking several times while talking Profound Visible frustration while talking IQ less than 20, require pervasive services and supports, conceptual skills Taking frequent pauses while talking generally involve the physical world rather than symbolic processes, very Distorting sounds when talking limited understanding of symbolic communication is speech or gesture Hoarseness (raspy and gravely sounding voice) Global Developmental Delay (GDD) Childhood-Onset Fluency Disorder/Stuttering Is the general term used to described a condition that occurs during the developmental period of a child between birth and 18 years Disturbance of the normal fluency and time patterning of speech that is inappropriate for the individual’s age It is usually defined by the child being diagnosed with having a lower intellectual functioning than what is perceive as ‘normal’ Disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic performance, individually Communication Disorders or in any combination Any disorder that affects an individual’s ability to comprehend, detect, or The onset of the symptoms is in the early developmental period apply language and speech to engage in discourse effectively with others. Later-onset causes are diagnosed as adult-onset fluency disorder Speech: is the expressive production of sounds and includes an individual’s articulation, fluency, voice and resonance quality Monosyllabic whole-word repetitions (ex: why-why-why did he go there?) Language: includes the form, function, and use of conventional system of Part-word or sound/syllable repetitions symbols in rule-governed manner of communication Prolongations of sounds Communication: includes any verbal or nonverbal behavior that influences the behavior, ideas, or attitudes of another individual. Audible or silent blocking (filled or unfilled pauses in speech) early childhood, to the extent that these “limit and impair everyday focus on one thing Words produced with an access of physical tension or struggle Tends to obsessively focus on one thing Social (Pragmatic) Communication Disorder Childhood Disintegrated Disorder / Heller’s Syndrome / Disintegrated Characterized by a primary difficulty with pragmatics, or the social use of Psychosis / Regressive Autism language and communication, as manifested by deficits in understanding and following social rules of verbal and nonverbal communication in naturalistic Rare condition characterized by late onset of developmental delays – or contexts, changing language according to needs of the listener or situation stunning reversals – in language, social function, and motor skills and following rules for conversation or story telling Researchers have not been successful in finding a cause for the disorder Delay in reaching language milestones Rett’s Disorder Little interest in social interactions Rare genetic neurological and developmental disorder that affects the way Going off-topic or monopolizing conversation the brain develops, causing a progressive inability to use muscles for eye and body movements and speech. It occurs almost exclusively in girls Not adapting language to different listeners (Ex: talks the same way to an adult as to a friend) Seem to develop normally at first, but after about 6 months of age, they lose skills they previously had – such as the ability to crawl, walk, communicate or Not adapting language to different situations (Ex: speaks the same way in the use their hands classroom as on the playground) Severity Levels for Autism Spectrum Disorder Not giving background information when speaking to an unfamiliar person Level 1: Requiring Support Not understanding how to properly greet people, request information or gain attention Without supports in place, deficits in social communication cause noticeable impairments Tendency to be overly literal and not understand riddles and sarcasm Has difficulty initiating social interactions and demonstrates clear examples Trouble understanding nonverbal communication (Ex: facial expression) of atypical or unsuccessful responses to social overtures of others. May appear to have decrease interest in social interactions The onset of symptoms is in the early developmental period Rituals and Repetitive Behaviors (RRB’s) cause significant interference with Autism Spectrum Disorder (Pervasive Developmental Disorder/Autistic functioning in one or more contexts. Resist attempts by others to interrupt Disorder/Mindblindedness) (ASD) RRB’s or to be redirected from fixated interest Autistic Savant/Savant Syndrome: individuals who score very low IQ tests, Level 2: Requiring Substantial Support while demonstrating exceptional skills or brilliance in specific areas, such as rapid calculation (hypercalculia), art, memory, or musical ability Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social Prodigy: focuses on results or achievement: a child, typically under the age interactions and reduced or abnormal response to social overtures from of ten, who can perform at an adult professional level in a highly demanding others culturally recognized field of endeavor RRB’s and/or preoccupations or fixated interests appear frequently enough Onset in early childhood to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are Symptoms limit and impair functioning interrupted; difficult to redirect from fixated interest Deficits in social communication and social interactions as exhibited by the Level 3: Requiring Very Substantial Support following: Severe deficits in verbal and nonverbal social communication skills cause Nonverbal behaviors such as eye contact, facial expression, body language severe impairments in functioning; very limited initiation of social Development of peer relationships appropriate to developmental level interactions and minimal response to social overtures from others. Not cuddly and no fear of real dangers Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are Social or emotional reciprocity such as not approaching others, not having interrupted; very difficult to redirected from fixated interest or returns to it back-and-forth conversation, reducing sharing of interest and emotions quickly Restricted, repetitive behavior patterns, interests, or activities exhibited by at Attention-Deficit/Hyperactivity Disorder (ADHD) least two of the following: Six or more manifestations of inattention present for at least 6 months to a Stereotyped or repetitive speech, motor movements, or use of objects (ex: maladaptive degree and greater than what would be expected given a hand flap, head bang, twirl) person’s developmental level (careless mistakes, not listening well, not following instructions, easily distracted, forgetful in daily activities, fidgeting, Excessive adherence to routines, rituals in verbal or nonverbal behavior, or running about inappropriately, restlessness) extreme resistance to change Continue or persist until adulthood Very restricted interest that are abnormal in focus, such as preoccupation with parts of objects Present before age 12 in two or more setting (home, school, or work) Hyper- or hyporeactivity to sensory input or unusual interest in sensory For people age 17 or older, only five signs of inattention and/or five signs of environment, such as fascination with lights or spinning objects. hyperactivity-impulsivity are needed to meet the diagnosis Forms of Autism (DSM IV) Male > Female 2:1 Asperger’s Disorder Key features: hyperactivity, impulsivity, and distractibility (Schizophrenia in adults) Persistent difficulties with social communication and social interaction and restricted and repetitive patterns of behaviors, activities or interests since Externalizing Disorders Some children may experience difficulties in a variety or area while others may have problems only with specific activities Predominantly Inattentive Type: Children whose problems are primarily those of poor attention. Children with DCD usually have normal or above average intellectual abilities. However, their motor coordination difficulties may impact their academic Predominantly Hyperactive-Impulsive Type: Children whose difficulties result progress, social integration and emotional development primarily from hyperactivity/impulsive behavior Dyspraxia or Clumsy Child Syndrome: inability to coordinate Combined Type: Children who have both sets of problems Stereotypic Movement Disorder Etiology of ADHD Condition in which a person makes repetitive, purposeless movements Genetics Factors Ex: hand waving, body rocking, or head banging Neurobiological Factors The movements interfere with normal activity or have the potential to cause Perinatal and prenatal Factors bodily harm Cocaine, led, alcohol, nicotine all increase dopamine that leads to brain The onset of symptoms is in the early developmental period infections Causes of Stereotypic Movement Disorder Mother’s use of nicotine: most common cause Stimulant drugs such as cocaine and amphetamines can cause a severe, short Environmental toxins period of stereotypic movement behavior. Specific Learning Disorder (Learning Disorder) Long-term stimulant use may lead to longer periods of the behavior Academic performance that is substantially below what would be expected Head injuries may also cause stereotypic movements given the person’s age, intelligence quotient score, and education for at least 6 months. Tic Disorders Significant interference with academic achievement or activities of daily living Tourette’s Disorder (TS) The learning difficulties begin during school-age years but may not become If you have a Tourette’s syndrome, you make unusual repeated, sudden, rapid, fully manifest until the demands for those affected academic skills exceed the non-rhythmic muscle movements including sound or vocalizations, called individual’s limited capacities. TICS Dyscalculia: difficulty in numbers or math facts You have little or no control over them Dysgraphia: inability to write Common tics are throat-clearing and blinking Dyslexia: inability to read You may repeat words, spin, or, rarely, blurt out swear words. Dysorthographia: inability to spell in writing TS often report as substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed against their will Dysfluency: inability to speak properly Begin between the ages 2 to 21, and last throughout life Motor Disorders (Motor Skills Disorders) Both multiple motor and one or more vocal tics have been present at some Disorders of the nervous system that cause abnormal involuntary time during the illness, although not necessarily concurrently movements. They can result from damage to the motor system. The tics may wax and wane in frequency but have persisted for more than 1 Developmental Coordination Disorder (DCD) year since first tic onset Motor skill disorder that affects five to six percent of all school-aged children. Onset is before 18 The ratio of boys to girls varies from 2:1 to 5:1 depending on the group Simple studied Motor: eye blinking, head jerking, shoulder shrugging, facial grimacing, nose By definition, children with DCD do not have an identifiable medical or twitching neurological condition that explains their coordination problems. Vocal: throat clearing, braking noises, squealing, grunting, gulping, sniffing, 12 to18 months: a child’s fine motor skills improved steadily. Now she’s tongue clicking physically ready to grab hold of a crayon and start experimenting Complex: The onset of symptoms is in the early developmental period Motor: jumping, touching other people and things, twirling about, repetitive DCD occurs when a delay in the development of motor skills, or difficulty movements of the torso and limbs, pulling at clothing and self-injurious coordinating movements, result in a child being unable to perform common, actions including hitting or biting oneself everyday task. Vocal: uttering words or phrases Frequently described as “clumsy” or “awkward” by their parent and teachers Coprolalia: the involuntary utterance of inappropriate or obscene words Ex: dropping or bumping into objects Echolalia: repeating a sound, word or phrase just heard Slowness and inaccuracy of performance of motor skills Palilalia: repeating one’s own words Ex: Catching an object, using scissors or cutlery, handwriting, riding a bike or participating in sports Causes of Tourette’s Disorder Children with DCD have difficulty mastering simple motor activity It is unknown Ex: tying shoes or going down stairs, and are unable to perform age- Most common for boys appropriate academic and self-care task The tics usually start in childhood and may be worst in the early teens. Many people eventually outgrown them The symptoms of schizophrenia are usually classified into: Persistent (Chronic) Motor or Vocal Tic Disorder Positive Symptoms – any change in behavior or thoughts, such as hallucinations or delusions. It is a condition that involves quick, uncontrollable movements and vocal outburst (but not both) Negative Symptoms – where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often Neurotransmitters are chemicals that transmit signals throughout the brain. appear emotionless and flat. They may be misfiring or not communicating correctly. This causes the same “message” to be sent over and over again. The result is typical tic 3. Neurobiological Influences Tics usually start at age 5 or 6 and get worse until age 12. they often improve Cerebral Ventricles: Computed Tomography (CT) scans of patients with during adulthood schizophrenia have consistently shown lateral and third ventricular enlargement and some reduction in cortical volume Chronic motor tic disorder is more common than Tourette syndrome. Chronic tics may be forms of Tourette syndrome Limbic System: studies of postmortem brain samples from schizophrenic patients have shown a decrease in the size of the region including the Both multiple motor and one or more vocal tics have been present at some amygdala, the hippocampus, and the Para hippocampal gyrus. time during the illness, although not necessarily concurrently Prefrontal Cortex: there is considerable evidence from postmortem brain The tics may wax and wane in frequency but have persisted for more than 1 studies that supports anatomical abnormalities in the prefrontal cortex in year since first tic onset schizophrenia functional deficits in the prefrontal brain imaging region have also been demonstrated. Onset before 18 Thalamus: some studies of the thalamus show evidence of volume shrinkage Provisional Tic Disorder or neuronal loss. The total number of neurons, oligodendrocytes, and astrocytes is reduced by 30 to 45 percent in schizophrenic patients It is a temporary condition in which a person makes one or many brief, repeated, movements or noises (tics). These movements or noises are 4. Prenatal and Perinatal Influences involuntary Viral infections Tics are common in children and may last for less than one year Influenza Onset is before 18 years Pregnancy complications Criteria have never been met for Tourette’s disorder or persistent (Chronic) motor or vocal tic disorder Bleeding Causes of Provisional Tic Disorder Delivery Complications The cause of provisional tic disorder can be physical or mental (psychological). Asphyxia: lack of oxygen It may be a mild form of Tourette syndrome. Chronic and early use of Marijuana Abnormalities in the brain may also be responsible for tic disorders. Such abnormalities are the cause of other mental conditions, such as depression Likely interact with genetics and environment and attention deficit hyperactivity disorder (ADHD) 5. Psychological and Social Influences Some research suggest that transient tic disorder could be linked to neurotransmitters. Stress Schizophrenia Spectrum Activates vulnerability Four Causes of Schizophrenia Increases relapse risk 1. The possible genes involved in schizophrenia Family relapse 2. The chemical action of the drugs that help many people with this Schizophrenogenic mother disorder Double-bind communication: double meaning communication 3. Abnormalities in the working of the brains of people with schizophrenia Downward Drift: low socioeconomic status. 4. Environmental risk factors that may precipitate the onset of Expressed Emotion (EE): high expressed emotion communication in a family symptoms are a good predictor of relapse among people with chronic schizophrenia Etiology Criticism, hostility, emotional over involvement 1. Genetic 6. Psychoanalytic Theories Family studies: other studies have found that people with schizophrenia in Sigmund Freud postulated that schizophrenia resulted from developmental their family histories have more negative symptoms than those whose fixations that occurred earlier than those culminating in the development of families are free from schizophrenia neuroses. Twin Studies: the risk for MZ twins (44.3 percent) is greater than that for DZ These fixations produce defects in ego development and Freud postulated twins (12.08 percent). that such defects contributed to the symptoms of schizophrenia. 2. Neurotransmitter Ego disintegration in schizophrenia represents a return to the time when the ego was not yet, or had just begun, to be established. Serotonin: current hypotheses posit serotonin excess as a cause of both positive and negative symptoms in schizophrenia. 7. Learning Theories Dopamine plays a major role in the sensitivity of the reward system in the According to the learning theorists, children who later have schizophrenia brain, which is believed to guide pleasure, motivation, and energy in the learn irrational reactions and ways of thinking by imitating parents who have context of opportunities to obtain rewards their own significant emotional problems 1. Schizotypal (Personality) Disorder Later age of onset 5 or more symptoms Between 35 – 55 Blunted Female > Male Vague stereotypical, over elaborative speech Prognosis: better than Schizophrenia Ideas of reference Worse than other psychotic disorders Peculiar thinking Specify if: Suspiciousness With/without marked stressor(s) Few close relationships With postpartum Onset: if onset is within 4 weeks of Postpartum Excessive social anxiety Attenuated Psychosis Syndrome Magical thinking Is a mental condition that causes clinically significant distress and is distinguished by the onset of the mind, psychotic-like symptoms that do not Eccentric appearance meet the full diagnostic criteria of one the psychotic disorders like schizophrenia, schizoaffective disorder, or delusional disorder Schizotypal either has hallucinations or delusions One ore more symptoms of schizophrenia but is aware of these unusual 2. Delusional Disorder experiences Delusions of at least 1 month’s duration 4. Shared Psychotic Disorder or Folie A Deux (DSM IV-TR) Functioning is not markedly impaired and behavior not obviously odd or A delusion develops in an individual in the context of a close relationship with bizarre another person who has an already established delusion If there are mood episodes, the total duration is relatively brief compared The delusion is similar in context to that of the person with whom they share with the delusional period a close relationship Specify type: 5. Schizoaffective Disorder Erotomaniac type Symptoms of Schizophrenia and at some time there is either a Major Depressive Episode, a Manic episode or a Mixed Episode Jealous type During the same period of illness, there have been delusions or hallucinations Mixed type for at least 2 weeks in the absence of symptoms meeting mood disorder Control type: false belief that other person, group of people, or external criteria force controls one’s general thoughts, feelings, impulses, or behavior. No Improvement without treatment Reference type: believing that people are talking about him/her Disorders are independent Grandiose type: (ex: belief that he is the only one that can rid the world of Symptoms that meet criteria for mood episode are present for a substantial crime and pain) portion of the total duration of the active and residual periods of illness Persecutory type: (ex: believing that your workmates put small pebbles in Criterion B of Schizoaffective: differentiates the disorder from mood your computer system so that the machine will get frozen and his work is left disorders with psychotic episodes undone) 6. Schizophreniform Disorder Religious type: (ex: believing that you are communicating directly with a higher being and is being listened to from up above) Presence of symptoms of the schizophrenia but the episode of the disorder lasts at least 1 month but less than 6 months Somatic type: (ex: believing that miniature heads are coming out of one’s shoulder) Do not acquire impaired social and occupational functioning Nihilistic type: (ex: believing that a big, powerful tidal wave will come Associated with good premorbid functioning consume the city and will wipe out the entire communities of people) Most resume normal lives Nihilistic By Proxy: if others believe the delusion Schizophreniform Provisional: when client has not yet recovered in the Hero worship stage: 6-12 years old duration of the disorder Unspecified type. Specify if: with/without good Prognostic Features 3. Brief Psychotic Disorder 7. Schizophrenia Presence of 1 or more of the ff. symptoms: One form of psychosis Delusions Psychosis: experiences of hallucinations, delusions, and loss of contact with reality Disorganized speech Persons lose touch with reality develops around late teenage years or early Hallucinations childhood Grossly disorganized or catatonic behavior Duration of disturbance is at least 6 months Duration of an episode of the disturbance is at least 1 day but less than 1 Lifetime prevalence is higher in males month with eventual full return to the premorbid level of functioning Inhibited dorsolateral prefrontal cortex Conflicting evidence about the biological or the psychological influences Active Broca’s area 2. Hallucinations Devastating, not only to the patient but also to the family False sensory perception. May be normal in early morning waking Greek word schizein meaning “to split”, and phren, meaning “mind” Auditory type: most common Neuroplastic or antipsychotics: group of drugs for treating schizophrenia Visual type: substance intoxication Key persons Involved In Schizophrenia Tactile type: substance withdrawal Paul Eugene Bleuler 3. Ambivalence Coined the term schizophrenia April 24, 1908 Contrasting feelings toward the same person at the same time He thought of it as breaking of associative threads 4. Abnormal or Disorganized Thought and Speech Characterized by a broad spectrum of cognitive and emotional dysfunctions Trouble organizing their daily routines of bathing, dressing properly, and including delusions and hallucinations, disorganized speech and behavior, eating regularly and inappropriate emotions They may engage in socially acceptable behavior, such as public masturbation Emil Kraepelin Many are disheveled and dirty, sometime wearing few cloths on cold day or In 1883, he labeled the disorder Dementia Precox (preconscious dementia), heavy cloths on a very hot day. because he believe that the disorder results from premature deterioration of the brain 5. Delusions Paul Federn Ideas that an individual believes are true but are highly unlikely and often simply impossible; resist any attempts to make them realize they’re wrong Believed that their egos possessed insufficient cathectic energy, and that it was a lack rather than excess of narcissistic libido that caused a psychotic Self-Deceptions: thought of occasionally acknowledge that they may be individuals’ difficulties with the object. wrong Margaret Mahler Thought-broadcasting: is the belief that others can hear or are aware of an individual’s thought Emphasized schizophrenia occurs due to distortion in reciprocal relationship between mother and child which leads to dependence and withdrawal. Thought-insertion: one’s thoughts are not one’s own, but rather belong to someone else and have been inserted into one’s mind. 4 A’s of Schizophrenia Develops over a short period of time Affect, Ambivalence, Autism, & Associations Type 2 Schizophrenia/Negative Symptoms Symptoms Absence or insufficiency of normal behavior Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these 25% experience must be 1, 2, or 3. 1. Alogia Delusions, hallucinations, disorganized speech, grossly disorganized of catatonic behavior, and negative symptoms. Poverty of speech Level of Functioning The person may not initiate speech with others and, when asked direct question, may give brief, empty replies Markedly below the level achieved prior to the onset Reflects lack of thinking or motivation to speak In one ore more major areas, such as: work, interpersonal relations, and self- care 2. Affective Flattening Type 1 Schizophrenia/Positive Symptoms Blunted effect Active manifestations Severe reduction of absence of affective responses to the environment Obvious signs Face may remain immobile and body language is unresponsive Distortions of Normal Behavior May reflect severe anhedonia Exaggerations of excesses They were similar to people wearing masks because they do not show emotions when you would normally expect them to. 50-70% experience 3. Anhedonia 1. Bizarre of Disorganized Behavior Which drives from the combination of “a” (without) and the “hedonic” Frightening to others; display unpredictable and apparently untriggered (pertaining to pleasure) agitation – suddenly shouting, swearing, or pacing rapidly; may be responses to hallucinations or delusions Presumed lack of pleasure experienced by some people with schizophrenia Looseness of associations 4. Attention Impairment Stereotypy, waxy flexibility, peculiar movement Difficulty in focusing and maintain attention Stupor: very slow motor responses Deficits in the working memory (ability to hold information and manipulate it) Catatonia: disorganized behavior that affects unresponsiveness to the world; in catatonic excitement, the person becomes wildly agitated for no apparent Difficulty in keeping in touch with reality reason. 5. Avolition or Apathy Loss of motivation 6. Asocial Behavior/Asociality Lack of interest in social interaction 7. Anergia Abnormal lack of energy Three Phases of Schizophrenia Prodromal: present before people go into acute phases of schizophrenia Active or Acute: characterized by hallucinations, paranoid delusion, and extremely disorganized speech and behaviors Residual: present after they emerge from it Remission Partial remission: that the client partially shows disturbance or any sign of it returning Complete remission: that the client no longer shows disturbance or any sign of it returning Subtypes of Schizophrenia (DSM IV-TR) Catatonic type: prominent psychomotor disturbance such as catalepsy, waxy flexibility, stereotypy, negativism, posturing, mutism, stupor, excessive motor activity, peculiar movement, echolalia & echopraxia Undifferentiated type: mixed hallucinations and delusions; symptoms do not meet the criteria for the paranoid, disorganized, or catatonic Paranoid type: preoccupation with one ore more delusions or frequent auditory hallucinations Disorganized type or Hebephrenia: silly immature emotionality; disorganized speech, disorganized behavior & flat or inappropriate affect are all prominent; extreme social impairment Residual type: absence of prominent delusions, hallucinations, disorganized speech and grossly disorganized or catatonic behavior (presence of negative symptoms); long term with a lot of negative type of schizophrenia